Planning for the Next Decade of Value-Based Care: the CMS Innovation Center Strategy Refresh

In late October, the CMS Innovation Center revealed its thinking on the path ahead for value-based payment, articulating a vision for “a health care system that achieves equitable outcomes through high quality, affordable, person-centered care,” and committing to having nearly all Medicare and Medicaid beneficiaries in value-based care by 2030. The announcement was highlighted with a webinar that included CMS Administrator Chiquita Brooks-LaSure and CMMI Director Liz Fowler, along with other high-level Innovation Center officials.

A white paper outlining the Innovation Center’s Strategy Refresh provides a comprehensive look at past models and considerations for the future. The paper outlines goals for both providers and beneficiaries in the coming years, signaling the importance of both perspectives as the agency updates existing models and develops new ones. Major focuses include a plan to guide the next ten years of value-based care — focusing on health equity, expanding value-based models, streamlining opportunities for providers, and ensuring all Medicare and Medicaid members have access to person-centered accountable care.

The agency’s direction confirms that all health and social care providers who serve Medicare and Medicaid populations must have a value-based care strategy. Fee-for-service and old models of health care are losing relevance and being replaced as the momentum for new care models aligning outcomes, financial incentives and patient experience builds. Value-based care for Medicare and Medicaid is a central focus of this white paper and the direction of the Innovation Center. The major announcements in this paper tie to the agency’s vision that most beneficiaries will be in accountable care relationships — focused on patient needs, along with improved outcomes and controlled costs — in the coming decade.

By 2030, CMS commits that:

• All Medicare beneficiaries will be in accountable care relationships
• The vast majority of Medicaid beneficiaries will be in accountable care relationships
• All Innovation Center models will include some form of multipayer alignment

The paper also outlines other commitments for the future of the Innovation Center:

• Ensure health equity is embedded in every model
• Reduce the complexity of models and streamline the portfolio
• Support providers in model participation and taking risk through the release of CMS tools and data
• Ensure Medicare and Medicaid beneficiaries in underserved areas can access participating providers
• Focus on sustainability of model efforts and lasting care delivery transformation

A review of 10 years of work at the Innovation Center was published by the CMS team in Health Affairs earlier this summer — that work, along with external research, expert feedback and stakeholder engagement informed the strategy refresh.

While this is the most significant policy document released by CMMI in the current administration, it leaves many unanswered questions about what’s to come. The white paper is more of an outline of future priorities and goals as opposed to a tactical approach to implementing and expanding models focused on controlling costs and improving outcomes.

What is the Innovation Center?

The CMS Innovation Center (sometimes referred to as the Centers for Medicare and Medicaid Innovation, or CMMI) was created as part of the Affordable Care Act and focuses on the development and testing of innovative health care payment and delivery models. The Innovation Center has grown its portfolio of models focused on achieving better care for patients, better health for communities, and lower costs through improvements in the health care delivery system. Over the last 10 years, more than 50 models have been released, more than 28 million beneficiaries have been engaged in some way, and more than 500,000 providers have participated.

As outlined in the strategy refresh, the Innovation Center’s focus will continue to be the development and expansion of models focused on controlling costs while improving quality and outcomes. In the next decade, CMS also plans to focus on five strategic objectives to guide future models:

• Drive Accountable Care
• Advance Health Equity
• Support Innovation
• Address Affordability
• Partner to Achieve System Transformation

The strategy refresh also outlines a commitment from CMS to launch more Medicaid-focused models and to ensure that models are available to nearly all Medicaid members — recognizing that currently, many beneficiaries in underserved areas may not currently have access to participating providers or organizations.

To relieve burdens on providers, CMS commits to making models easier to participate in — with more straightforward descriptions, details, and resources for programmatic and financial requirements. CMS also intends to offer model participants support through releasing more timely and actionable data, extending regulatory and payment flexibilities, and conducting learning collaboratives.

What’s not in the paper?

This document is one of several documents released by CMS this year that outlines a vision and strategy for the nation’s Medicare and Medicaid programs. The documents clearly signal that the Biden-Harris Administration intends to pursue a different approach in innovation for Medicaid and Medicare populations than the previous administration. Eligibility restrictions, work requirements, and capped financing are off the table. However, there are no specifics about the long-term future of existing models or any hints of what future models may look like.

What can we expect in the future?

CMS suggested in both the paper and the webinar that existing models will continue, and there’s been no decision to end models early — however, some models may be updated to align with the highlighted priorities, including addressing social determinants of health and collecting data about beneficiary race and ethnicity to inform future health equity efforts.

CMS committed to focusing on transparency and communication as specific details and requirements are developed, aligning the future direction of the Innovation Center with lessons learned to date and feedback from stakeholders. The major next step for CMS is to conduct an extensive stakeholder engagement process over the next several months. The Health Care Payment and Learning Action Network will both serve as a resource and play a significant role in the development of future models and initiatives. Providers and stakeholders who have previous CMMI model experience or interest in engaging in the future can learn more at the Innovation Center strategy refresh website.

What’s your take on the strategic refresh for the Innovation Center? Do you have a strategy for the move to value-based care? If you’d like to learn more, or just share your thoughts — you can get in touch with me at kalin.scott@hsg.global or @kalinscot on Twitter.